Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection

MolDX-covered molecular tests for solid organ allograft rejection that meet LCD DL40062 criteria and have completed MolDX technical assessment are covered when billed per this policy; each service is billed as a single bundle (UOS=1). Specific tests are covered for organ- and intent-specific indications (for-cause vs surveillance) with defined post-transplant timing constraints (e.g., AlloMap >=55 days, Prospera lung >=28 days, VitaGraft >=12 days), and strict billing requirements including use of appropriate DEX Z-Codes and only one molecular service billed per patient encounter. Molecular tests and biopsies generally cannot be billed on the same date of service and no tests are approved for patients with multiple transplants.

"Molecular tests for assessing solid organ allograft rejection that meet the coverage criteria of LCD DL40062 and have completed MolDX technical assessment are covered when billed in compliance with..."